Kumiko Kikuchi

Major complications and outcome of diagnostic and operative transvaginal hydrolaparoscopy

Aim:  Transvaginal hydrolaparoscopy (THL) has recently been developed as a less invasive alternative to conventional laparoscopy. There are some reports that described the usefulness and prognostic value of diagnostic THL in infertile women. Moreover, operative THL such as ovarian drilling for unovulatory women with polycystic ovarian syndrome (PCOS) to induce ovulation has also been found to be as effective as that by conventional laparoscopy. The risk of bowel injury and sepsis by transvaginal access with culdoscopy was higher than that with laparoscopy in the previous reports. The purpose of the present study was to examine the risk of diagnostic and operative THL according to two case studies with a literature review.

Antinuclear Antibody Reduces the Pregnancy Rate in the First IVF‐ET Treatment Cycle but Not the Cumulative Pregnancy Rate without Specific Medication

Problem: It has been shown that the presence of antinuclear antibody (ANA) might reduce pregnancy rates after in vitro fertilization‐embryo transfer (IVF‐ET). However, the mechanism of implantation failure by ANA has not yet been clarified. This study was performed to investigate the impact of ANA on pregnancy rates after IVF‐ET, and the necessity of specific medication for infertile women who have ANA in their sera.

Serum Matrix Metalloproteinase and Tissue Inhibitor of Metalloproteinase Concentrations in Infertile Women Achieved Pregnancy Following IVF-ET

Matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) play important roles throughout various stages of pregnancy, including embryo implantation, trophoblastic invasion, placentation in early gestation, and cervical dilatation in later gestation, and feto‐maternal membrane lysis. It would be beneficial if assessment of serum concentrations of MMP and TIMP could predict successful implantation following in vitro fertilization‐embryo transfer (IVF‐ET). This study was performed to compare serum MMP and TIMP concentrations between patients with and without the establishment of pregnancy following ET.

Chemokine Bioactivity of RANTES is Elevated in the Sera of Infertile Women with Past Chlamydia trachomatis Infection

PROBLEM:  It has been shown that Chlamydia trachomatis infection in infertile women is highly associated with tubal pathology. Chlamydia trachomatis antibody testing is a simple screening test for tubal factor subfertility, however, it is based on the detection of previous infection. Recently, association between some inflammatory diseases and chemokines has been investigated. This study was performed to clarify the relationship between chemokines in the sera of infertile women and past C. trachomatis infection.

Effects of sera from infertile women with sperm immobilizing antibodies on fertilization and embryo development in vitro in mice

PROBLEM: This study was performed to investigate if patients’ sera with anti‐human sperm antibodies show inhibitory effects on in vitro fertilization (IVF) and embryo development in mice.

Establishment of criteria for elective single embryo transfer at day 2 or day 3 by analyzing cases with successful implantation of all embryos transferred

Aim:  Elective transfer of two good‐quality embryos has been used to avoid triplet or high‐order multiple pregnancies. However, the rate of twin pregnancies has remained fairly unchanged. In the present study, criteria for elective single embryo transfer (eSET) at day 2 or day 3 were established by analyzing cases with successful implantation of all embryos transferred.

Effects ofin vivo exposure to eggs with sperm-immobilizing antibodies in follicular fluid on subsequent fertilization and embryo developmentin vitro

AimsIt has been shown that supplementation of patients’ sera that contains sperm-immobilizing antibodies results in failure of fertilization and embryo developmentin vitro. The present study was carried out to investigate if exposing retrieved eggs to a high number of sperm-immobilizing antibodies in the follicular fluid (FF)in vivo affected subsequent fertilization and embryo developmentin vitro, even if they were washed with an antibody-free culture medium.MethodsPatients’ sera and their FF were collected in 15in vitro fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) treatment cycles from 11 infertile women with sperm-immobilizing antibodies in their sera. Quantitative sperm-immobilizing antibody titers (SI50 titers) in the sera and FF were evaluated. The fertilization rate, good-quality embryo rate and implantation rate by IVF-ET were compared between infertile patients having higher (10≤) SI50 titers and lower (< 10) SI50 titers in their FF.ResultsThere was a significant correlation in the SI50 titers between the patients’ sera and their FF (P < 0.0001). After thoroughly washing the collected eggs in culture medium without the patient’s serum before IVF, there was no difference in the fertilization rate in the patients with high (10≤) and low (< 10) SI50 titers in their FF (P = 0.62). However, the good-quality embryo rate in the patients with a high SI50 titer was significantly lower than patients with a low antibody titer (P < 0.05). There was no significant difference in the implantation rate between the two groups (P = 0.33).ConclusionsSimilar amounts of sperm-immobilizing antibodies existed in the patients’ FF and in their sera. ICSI did not seem to be necessary in patients having the antibodies if their sera were not supplemented in the culture media. Even with careful manipulation of eggs, it might be suggested that the harmful effects of sperm-immobilizing antibodies on embryo development cannot be completely avoided, especially in patients with high SI50 titers in the FF.

Infertile women without sensitization to an appropriate amount of sperm do not produce sperm-immobilizing antibodies in their sera

Background and AimThe factors that affect sperm immobilizing antibody production in some women are not fully understood. This study was performed to investigate if production of sperm immobilizing antibodies in women is associated with their husbands’ sperm count.MethodsThe sperm immobilization test (SIT) was performed on 221 infertile women whose husbands had normal semen characteristics according to the criteria by WHO; 160 patients were treated by intracytoplasmic sperm injection (ICSI) because of poor semen characteristics, and 1013 virgin female children acted as the controls.ResultsA significant difference of the incidence in SIT was observed between the virgin female children and the women whose husbands had a normal sperm count (P < 0.0001). There was also a significant difference of the incidence in SIT between the women treated by intracytoplasmic sperm injection (ICSI) because of a severe male factor and those whose husbands had a normal sperm count (P < 0.05).ConclusionsThese results indicate that production of sperm immobilizing antibodies in women begins after they have been exposed to a large enough amount of sperm. However, the precise amount of sperm required to produce the antibodies is not clarified by the present study.

Effects ofin vivoexposure to eggs with sperm-immobilizing antibodies in follicular fluid on subsequent fertilization and embryo developmentin vitro: Effect of ASA in follicle on IVF and embryo

Aims:  It has been shown that supplementation of patients’ sera that contains sperm‐immobilizing antibodies results in failure of fertilization and embryo development in vitro. The present study was carried out to investigate if exposing retrieved eggs to a high number of sperm‐immobilizing antibodies in the follicular fluid (FF) in vivo affected subsequent fertilization and embryo development in vitro, even if they were washed with an antibody‐free culture medium.

Severe ovarian hyperstimulation syndrome in a 42-year-old woman with successful pregnancy after intracytoplasmic sperm injection embryo transfer

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovulation induction for infertile women. It has been shown that patients suffering from OHSS are generally young because OHSS depends on the patient’s ovarian reserve. Therefore, women ≥40 years of age seldom suffer from the severe form of OHSS. In the present study, we report a case of severe OHSS that occurred in a 42-year-old woman with a successful pregnancy after intracytoplasmic sperm injection (ICSI)-embryo transfer. She had been diagnosed as having polycystic ovary syndrome (PCOS). After 5 cycles of unsuccessful treatment with gonadotropins plus intrauterine insemination for her husband’s asthenozoospermia, the treatment with assisted reproductive technology (ART) was indicated. In the third ART attempt, the patient was treated by ICSI-embryo transfer (ET) and she developed severe OHSS at 4 weeks’ gestation. On admission, marked hemoconcentration, oligouria and hypo-albuminemia were diagnosed. A continuous autotransfusion system of ascites, which was developed to expand circulating plasma volume without exogenous albumin, was carried out for 5 h at a rate of 100–200 mL/h once a day for a total of 5 days. The course of the pregnancy was uneventful. At 37 weeks’ gestation, a healthy baby boy weighing 3336 g was born by cesarean section when the patient was 43 years of age. The postoperative course was also uneventful. To the best of our knowledge, the present report describes the oldest woman showing severe OHSS.